Wednesday, Gov. Kay Ivey hosted a formal bill signing ceremony at the Alabama Capitol for this year’s Medication Assisted Treatment Act (“MAT Act”). Flanked by an array of both state and national leaders, the signing of this legislation represents another step Alabama is taking to combat the drug abuse epidemic and help those struggling with addiction.

Passing this bill was no easy feat, however. Introduced just six days before the 2019 Legislative Session ended, the Medical Association worked closely with Sen. Larry Stutts, M.D. in drafting the language for the bill and was instrumental in pushing it to final passage.

“It really is extraordinary what we were able to get done in such a short timeframe,” said Association President, John Meigs, M.D. “I know this was a priority for Senator Stutts, and we were proud to see it become a priority for all legislators. MAT has already been proven to help reduce drug addiction and I am anxious to see its impact in Alabama.”

The Alabama Board of Medical Examiners, with the guidance from a panel of industry stakeholders, is developing rules for medication assisted therapy in Alabama. If you would like to learn more about MAT and the federally-required qualifications for physicians, go to SAMHSA.gov. The Alabama Department of Mental Health also has information about MAT listed here, and a list of current grants for addiction treatment can be found here.

The nation has been grappling with an opioid crisis for years. In 2017 alone, there were 47,600 opioid-related overdose deaths in the United States. It continues to be a public health emergency. U.S. Department of Health & Human Services Office of the Inspector General has been tracking opioid use in Medicare during this crisis, particularly since 2016.

In a statement, the Centers for Medicare & Medicaid Services said: “Fighting the opioid epidemic has been a top priority for the Trump administration. We are encouraged by the OIG’s conclusion which finds significant progress has been made in our efforts to decrease opioid misuse while simultaneously increasing medication-assisted treatment in the Medicare Part D program.”

OIG has identified beneficiaries at serious risk of misuse or overdose and has identified prescribers with questionable prescribing for these beneficiaries. These types of analyses are crucial to understanding and addressing the national opioid crisis. Building on past OIG work, this data brief details opioid use in Medicare Part D in 2018 and trends in drugs used to treat opioid use disorder.

We based this data brief on an analysis of Part D prescription drug event records for opioids received in 2018. We determined the beneficiaries’ morphine equivalent dose, which is a measure that converts all of the various opioids and strengths into one standard value.

WHAT WE FOUND

Alabama had the highest proportion of beneficiaries receiving opioids through Medicare Part D, while Hawaii had the lowest proportion.

Nearly 3 in 10 Medicare Part D beneficiaries received opioids in 2018, a significant decrease from the previous 2 years.

At the same time, the number of beneficiaries receiving drugs for medication-assisted treatment for opioid use disorder has steadily increased and reached 174,000 in 2018.

In addition, the number of beneficiaries receiving prescriptions through Part D for naloxone-a drug that can reverse the effects of an opioid overdose-more than doubled from 2017 to 2018.

About 354,000 beneficiaries received high amounts of opioids in 2018, with about 49,000 of them at serious risk of opioid misuse or overdose; this was fewer than in the previous 2 years.

About 200 prescribers had questionable opioid prescribing for beneficiaries at serious risk.

WHAT WE CONCLUDE

Progress has been made in decreasing opioid use in Part D, increasing the use of drugs for medication-assisted treatment, and increasing the availability of naloxone. It is imperative for the Department of Health and Human Services-including CMS and OIG-to continue to implement effective strategies and develop new ones to address this epidemic.

The Alabama Department of Mental Health is interested in partnering with physicians and other medical professionals who provide medication-assisted treatment (MAT) in the black belt counties and surrounding counties. As part of this initiative, ADMH is currently developing a Center of Excellence (COE) which will be located in one of these counties. Physicians will have the opportunity to partner with the COE to assist in providing MAT to this underserved area of the state. Physicians who participate in a formal partnership with the COE will be eligible for enhanced rates of pay as related to MAT.

To participate in the formal partnership, a physician must be an approved Data 2000 Waived Physician and be able to demonstrate the ability to provide appropriate counseling services, either directly or through a partnership with an ADMH certified substance abuse provider, and appropriate medical care, including the prescribing of medications used to treat Opioid Use Disorders.

How does a physician apply for a physician waiver to prescribe and dispense buprenorphine? Under the Drug Addiction Treatment Act of 2000 (DATA 2000), qualified physicians may apply for waivers to treat opioid dependency with approved buprenorphine products in any settings in which they are qualified to practice, including an office, community hospital, health department, or correctional facility. A “qualifying physician” is specifically defined in DATA 2000 as one who is:

Licensed under state law (excluding physician assistants or nurse practitioners)

Alabama Department of Mental Health has partnered with the Alabama Department of Public Health on a grant to increase awareness of substance use disorders among primary care professionals. This grant will allow ADMH to pay the registration fee only for any of the following to attend the Alabama School of Alcohol and Other Drug Studies (ASADS):

MD

DO

PA

CRNP

CNM

RN

The Medical Foundation of Alabama designates this live activity for a maximum of 27 AMA PRA Category 1 Credit(s)™.

ASADS has been conducting conferences for over 43 years. Over the past couple of years, there has been a heavy emphasis in the community and at the state level to begin to develop a system of care that integrates primary care and substance abuse treatment. There are many great speakers at this year’s conference.

This course is designed for MDs, DOs, PAs and CRNPs who are interested in becoming a 2000 Data Waived physician. This class will be held from 8 a.m. – 5 p.m. to meet the 8-hour requirement.

Course Description:

This presentation is designed to train qualified physicians in dispensing or prescribing specifically approved Schedule III, IV and V narcotic medications for the treatment of opioid addiction in an office-based setting. The goal of this training is to acquire the knowledge and skills needed to provide optimal care to opioid use disorder patients by providing:

This eight-hour training, which will include eight separate modules and four case studies. Each of the speakers will be presenting for two hours. The remaining two hours are broken up over the four case studies. Designated by the DHHS, this training meets the eight-hour requirement and is designed for physicians to dispense buprenorphine in office practice for treatment of opioid use disorder. Participation in this training will provide physicians with a comprehensive overview of buprenorphine prescribing and its safe and effective use in an office-based setting. This training is designed for physicians and other primary care providers who are likely to treat opioid-dependent persons in their practice, such as those in family practice, general internal medicine, psychiatry, pediatrics, adolescent medicine specialists, and Opioid Treatment Programs.

Course Objectives:

After attending the course, a participant will be able to:

• review addiction treatment in office-based practices;

• discuss the pharmacological treatments of opioid use disorder;

• determine what medical record documentation must be followed;

• discuss the process of buprenorphine induction as well as stabilization and maintenance techniques;

• describe how to take a patient history and evaluation; and

• review safety concerns and drug interactions.

Dr. Merrill Norton, Ph.D., will be conducting a three-part series on The Pain of Pleasure: A Pharmacist’s Guide to Opioid Use Disorders for Prescribers and Other Healthcare Professionals.

Dr. Cardwell Nuckols, Ph.D. – The Neurobiology of Addiction: The Addiction Process in Three Stages